Healthcare Provider Details

I. General information

NPI: 1588531206
Provider Name (Legal Business Name): SEA STEPS PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TIMBER TRAIL RD
RICHMOND HILL GA
31324-9415
US

IV. Provider business mailing address

99 WAVERLY LN
RICHMOND HILL GA
31324-7805
US

V. Phone/Fax

Practice location:
  • Phone: 912-803-0679
  • Fax:
Mailing address:
  • Phone: 404-803-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: GINA HALDEMAN
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 404-803-0679